Blood pressure control is fundamental to keeping your heart, kidneys and brain healthy. But sometimes it is far from easy! Doctors may need to prescribe more than one drug, but combining BP drugs must be done only with great care.
Combining BP Drugs Can Be Risky:
Q. My doctor has me taking an ACE inhibitor blood pressure medication called lisinopril and an ARB called Diovan (valsartan). These drugs make me dizzy and sap my energy. I have headaches, heart palpitations and gastrointestinal problems. Whenever I complain I am pretty much told to suck it up and that my symptoms are all in my head.
At my last doctor’s visit, my blood pressure was 140/90. Instead of getting an “attaboy” and congratulated, I was told to up the dosage.
A. Yikes! The very first question to ask your doctor is whether it is appropriate to combine lisinopril (an ACE inhibitor) with valsartan (Diovan) which is an ARB (angiotensin receptor blocker). A Canadian study found that combining ACE inhibitors with ARBs increased the risk of kidney damage and potassium overload, especially in older patients. The European Medicines Agency has warned that no two types of drugs that affect the renin-angiotensin system should be prescribed together.
No Aliskiren with ACE Inhibitors or ARBs:
The FDA put out an alert about combining similar drugs in certain patients. On April 20, 2012, the agency warned doctors to be cautious about prescribing aliskiren (Amturnide, Tekturna, Tekturna HCT, and Tekamlo) in combination with ACE inhibitors or ARBs such as candesartan (Atacand), irbesartan (Avapro), olmesartan (Benicar), losartan (Cozaar), valsartan (Diovan), telmisartan (Micardis) or eprosartan (Teveten) in patients with diabetes or kidney problems.
Aliskiren affects the renin-angiotensin system, as do ACE inhibitors and ARBs. The combination of aliskiren and an ARB increased the risk for high potassium levels and kidney damage in people dealing with diabetes. That same day, the drug manufacturer Novartis withdrew its drug Valturna, a fixed combination of aliskiren and valsartan, from US markets.
No Advantage to Combining ACE Inhibitors with ARBs:
More recently, a review of large trials (more than 1,000 participants) found that both types of drugs can be effective at lowering blood pressure and protecting the heart (Therapeutic Advances in Cardiovascular Disease, June 2016). The author cautions against combining BP drugs from these two classes, however.
How Low Should You Go?
We get concerned whenever we hear that older people are encouraged to strive for a blood pressure reading of 120/80 with medications. When anti-hypertensive drugs cause dizziness, fatigue, heart palpitations, headaches and digestive distress, the “cure” may be causing more problems than the condition being treated. We wrote more about this controversy here.
ACE Inhibitor Cough:
Visitors to this website have described other drug-induced side effects that have often gone under appreciated:
“I took lisinopril for a few weeks before realizing it was causing an unacceptable problem with coughing (coughing until I threw up!) My doctor put me on Diovan. It was more costly, but it worked without the coughing.” Glenda
“I took lisinopril for many years and every time I complained to my doctor who had prescribed it, about the constant nagging cough, he just prescribed cough medicine! He never told me it was the lisinopril!
“When the coughing was so bad I wet myself, he prescribed a drug for incontinence!
“After 8 years, I changed doctors due to reaching 65 and going on Medicare. (My former doctor didn’t take Medicare patients.) The new doc took me off the lisinopril immediately (explained that was the connection) and put me on losartan; the cough went away in less than a week. No more cough equaled no more losing control of bladder so he told me to toss the cough med and the incontinence med!” C.R.L.
“My doctor actually told me that the lisinopril cough was good for me! He gave me some medical mumbo-jumbo explanation of how coughing uncontrollably all day and night was not bad!” B.L.
“When I asked my doctor about my horrible dry cough after taking Benicar for a long time, she assured me it must be allergies as my lungs were clear. Also, I had experienced nerve pain in my feet and itching all over. I stopped taking Benicar. My BP went up to 135/75 and my cough stopped as well as the pain in my feet and itching.” G.G.
“I took Benicar and Cozaar for a year plus, and developed a horrible cough. Cardiologist said could not be the medicine. Internist said it could.” E.M.F.
We have received hundreds of reports of ACE inhibitor cough linked to drugs like lisinopril. To read other stories, here is a link.
To learn more about other ways to control blood pressure, we suggest our book, Best Choices from The People’s Pharmacy. We offer a great many natural approaches to controlling hypertension with food and supplements. You can also find hints in our Guide to Blood Pressure Treatment.
All our publications can be found here.
Do not let your blood pressure medicine cause complications that affect the quality of your life. Always communicate with your physician what is going on. Share your own story with such medications below. What has worked for you without causing side effects.